Intensive care survivors’ experiences of ward-based care: Meleis’ theory of nursing transitions and role development among critical care outreach services.

Aims and objectives. To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Background. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Design and methods. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.’s mid-range theory on experiencing transitions. Results. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. Conclusion. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Relevance to clinical practice. Meleis et al.’s work has resonance in terms of explicating intensive care patients’ experiences of psychosocial distress throughout the transition to general ward–based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed.

CATEGORIZATION OF BRAZILIAN INTERNET USERS AND ITS IMPACTS ON THE USE OF ELECTRONIC GOVERNMENT SERVICES

This paper aims to categorize Brazilian Internet users according to the diversity of their online activities and to assess the propensity of these Internet users´ groups to use electronic government (e-gov) services. The Amartya Sen’s Capability Approach was adopted as the theoretical framework for its consideration of people’s freedom to decide on their use of available resources and their competencies for these decisions, leading to the use of e-gov services. Multivariate statistical techniques were used to perform data analysis from the 2007, 2009 and 2011 editions of ICT Household Survey. The results showed that Internet users belonging to the advanced and intermediate use groups were more likely to use e-gov services than those who belong to the sporadic use group. Moreover, the results also demonstrated that the Internet user group of intermediate use presented a higher tendency to use e-gov services than the Internet user group of advanced use. This tendency is possibly related to the extensive use of interactive and collaborative activities of leisure and entertainment performed by this type of user. The findings of this research may be useful in guiding public policies for the dissemination and provision of electronic government services in Brazil.

STUDY ON THE USE AND QUALITY OF INFORMATION BY INTERNET DOCUMENTARY OF STUDENTS OF THE UNIVERSITY, COSTA RICA: CASE LABORATORY LIBRARY ROOM Joaquin Garcia Monge

It is no secret that computer services came to revolutionize the world. More than a service, have since become an indispensable tool for humanity, because they simplify and make life easier in many of his orders, through its various support options. These advances are added Internet services, so that by the mid 1980's assessed the need for such a research tool in order to apply it in various fields of human knowledge.This research, based on the use and quality of documentary information from the Internet, with application to the students of the Universidad Nacional, Costa Rica, if the Library Board Laboratory Joaquin Garcia Monge, develops in the form of theses.

Health planning & health services research /

Description based on: Oct. 16, 1979.

Maximizing real-time streaming services based on a multi-servers networking framework

In recent years, we have witnessed substantial exploitation of real-time streaming applications, such as video surveillance system on road crosses of a city. So far, real world applications mainly rely on the traditional well-known client-server and peer-to-peer schemes as the fundamental mechanism for communication. However, due to the limited resources on each terminal device in the applications, these two schemes cannot well leverage the processing capability between the source and destination of the video traffic, which leads to limited streaming services. For this reason, many QoS sensitive application cannot be supported in the real world. In this paper, we are motivated to address this problem by proposing a novel multi-server based framework. In this framework, multiple servers collaborate with each other to form a virtual server (also called cloud-server), and provide high-quality services such as real-time streams delivery and storage. Based on this framework, we further introduce a (1-?) approximation algorithm to solve the NP-complete "maximum services"(MS) problem with the intention of handling large number of streaming flows originated by networks and maximizing the total number of services. Moreover, in order to backup the streaming data for later retrieval, based on the framework, an algorithm is proposed to implement backups and maximize streaming flows simultaneously. We conduct a series of experiments based on simulations to evaluate the performance of the newly proposed framework. We also compare our scheme to several traditional solutions. The results suggest that our proposed scheme significantly outperforms the traditional solutions.

Changes in physical activity following a genetic-based internet-delivered personalized intervention: randomized controlled trial (Food4Me)

Background: There is evidence that physical activity (PA) can attenuate the influence of the fat mass- and obesity-associated (FTO) genotype on the risk to develop obesity. However, whether providing personalized information on FTO genotype leads to changes in PA is unknown. Objective: The purpose of this study was to determine if disclosing FTO risk had an impact on change in PA following a 6-month intervention.

Methods: The single nucleotide polymorphism (SNP) rs9939609 in the FTO gene was genotyped in 1279 participants of the Food4Me study, a four-arm, Web-based randomized controlled trial (RCT) in 7 European countries on the effects of personalized advice on nutrition and PA. PA was measured objectively using a TracmorD accelerometer and was self-reported using the Baecke questionnaire at baseline and 6 months. Differences in baseline PA variables between risk (AA and AT genotypes) and nonrisk (TT genotype) carriers were tested using multiple linear regression. Impact of FTO risk disclosure on PA change at 6 months was assessed among participants with inadequate PA, by including an interaction term in the model: disclosure (yes/no) × FTO risk (yes/no).

Results: At baseline, data on PA were available for 874 and 405 participants with the risk and nonrisk FTO genotypes, respectively. There were no significant differences in objectively measured or self-reported baseline PA between risk and nonrisk carriers. A total of 807 (72.05%) of the participants out of 1120 in the personalized groups were encouraged to increase PA at baseline. Knowledge of FTO risk had no impact on PA in either risk or nonrisk carriers after the 6-month intervention. Attrition was higher in nonrisk participants for whom genotype was disclosed (P=.01) compared with their at-risk counterparts.

Conclusions: No association between baseline PA and FTO risk genotype was observed. There was no added benefit of disclosing FTO risk on changes in PA in this personalized intervention. Further RCT studies are warranted to confirm whether disclosure of nonrisk genetic test results has adverse effects on engagement in behavior change.

Building cloud-based healthcare data mining services

The linkage between healthcare service and cloud computing techniques has drawn much attention lately. Up to the present, most works focus on IT system migration and the management of distributed healthcare data rather than taking advantage of information hidden in the data. In this paper, we propose to explore healthcare data via cloud-based healthcare data mining services. Specifically, we propose a cloud-based healthcare data mining framework for healthcare data mining service development. Under such framework, we further develop a cloud-based healthcare data mining service to predict patients future length of stay in hospital.

Agent based risk patient management

This paper explores the role of information and communication technologies in managing risk and early discharge patients, and suggests innovative actions in the area of E-Health services. Treatments of chronic illnesses, or treatments of special needs such as cardiovascular diseases, are conducted in long-stay hospitals, and in some cases, in the homes of patients with a follow-up from primary care centre. The evolution of this model is following a clear trend: trying to reduce the time and the number of visits by patients to health centres and derive tasks, so far as possible, toward outpatient care. Also the number of Early Discharge Patients (EDP) is growing, thus permiting a saving in the resources of the care center. The adequacy of agent and mobile technologies is assessed in light of the particular requirements of health care applications. A software system architecture is outlined and discussed. The major contributions are: first, the conceptualization of multiple mobile and desktop devices as part of a single distributed computing system where software agents are being executed and interact from their remote locations. Second, the use of distributed decision making in multiagent systems, as a means to integrate remote evidence and knowledge obtained from data that is being collected and/or processed by distributed devices. The system will be applied to patients with cardiovascular or Chronic Obstructive Pulmonary Diseases (COPD) as well as to ambulatory surgery patients. The proposed system will allow to transmit the patient's location and some information about his/her illness to the hospital or care centre

2007-2008 Juvenile Court Services School Liaison Program Data, July 2008

Data are provided to CJJP through statistical summary forms completed by the JCSLs. Because forms are completed only when meaningful contact between a student and a liaison takes place, only a portion of the total population served is reported. Meaningful contact is defined as having at least five contacts within a 60-day period (at any point during the academic year) regarding at least one of the referral reasons supplied on the form. Data are entered into a web-based application by the liaisons and retrieved electronically by CJJP via the internet. Service information is submitted and uploaded only at the end of the academic year.

2010-2011 Juvenile Court Services School Liaison Program Data, July 2011

Data are provided to CJJP through statistical summary forms completed by the JCSLs. Because forms are completed only when meaningful contact between a student and a liaison takes place, only a portion of the total population served is reported. Meaningful contact is defined as having at least five contacts within a 60-day period (at any point during the academic year) regarding at least one of the referral reasons supplied on the form. Data are entered into a web-based application by the liaisons and retrieved electronically by CJJP via the internet. Service information is submitted and uploaded only at the end of the academic year.

2012-2013 Juvenile Court Services School Liaison Program Data, July 2013

Data are provided to CJJP through statistical summary forms completed by the JCSLs. Because forms are completed only when meaningful contact between a student and a liaison takes place, only a portion of the total population served is reported. Meaningful contact is defined as having at least five contacts within a 60-day period (at any point during the academic year) regarding at least one of the referral reasons supplied on the form. Data are entered into a web-based application by the liaisons and retrieved electronically by CJJP via the internet. Service information is submitted and uploaded only at the end of the academic year.

Modelling Denial of Service Attacks on JFK with Meadow's Cost-Based Framework

We present the first detailed application of Meadows’s cost-based modelling framework to the analysis of JFK, an Internet key agreement protocol. The analysis identifies two denial of service attacks against the protocol that are possible when an attacker is willing to reveal the source IP address. The first attack was identified through direct application of a cost-based modelling framework, while the second was only identified after considering coordinated attackers. Finally, we demonstrate how the inclusion of client puzzles in the protocol can improve denial of service resistance against both identified attacks.

Extending conceptual models for Web based applications

The next phase envisioned for the World Wide Web is automated ad-hoc interaction between intelligent agents, web services, databases and semantic web enabled applications. Although at present this appears to be a distant objective, there are practical steps that can be taken to advance the vision. We propose an extension to classical conceptual models to allow the definition of application components in terms of public standards and explicit semantics, thus building into web-based applications, the foundation for shared understanding and interoperability. The use of external definitions and the need to store outsourced type information internally, brings to light the issue of object identity in a global environment, where object instances may be identified by multiple externally controlled identification schemes. We illustrate how traditional conceptual models may be augmented to recognise and deal with multiple identities.